Active NPI
Alexander Wilson, PT, DPT
- Physical Therapist
- Tyler, TX
National Provider Identifier
1124904859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1407082
- Practice address
- 5759 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6231 - Phone
- (903) 405-4899
- Fax
- (903) 638-2741
- NPI assigned
- Aug 15, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1407082 | TX | Primary |
Addresses
Primary practice location
5759 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6231
Mailing address
1731 McDonald Rd
Tyler, TX 75701-4724
Phone (903) 274-9977
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407082 | Other | TX | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5759 Eagles Nest Blvd
Suite 4
Tyler, TX 75703-6231
Phone (903) 405-4899
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lonestar Physical Therapy & Sports Performance LLC | Physical Therapist | Current | Accepting new patients |
Locations
5759 Eagles Nest Blvd
Ste 4
Tyler, TX 75703
Phone (903) 405-4899
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopedic Physical Therapist
- Tyler, TX
- NPI 1326779323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755216000000",
"number": "1124904859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1731 MCDONALD RD",
"city": "TYLER",
"state": "TX",
"postal_code": "757014724",
"telephone_number": "903-274-9977",
"fax_number": "903-638-2741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5759 EAGLES NEST BLVD STE 4",
"city": "TYLER",
"state": "TX",
"postal_code": "757036231",
"telephone_number": "903-405-4899",
"fax_number": "903-638-2741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ALEXANDER",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-15",
"last_updated": "2025-08-15",
"certification_date": "2025-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1407082",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "1407082",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.